I can’t explain how much even a slight bit the upping from 5mcg T3 to 10mcg T3 has started to help me. The black bags under my eyes have slightly subsided, but I am still feel slightly lethargic. Working on my iron levels though my GP ignorantly said this morning that my exhaustion could be more ‘mentally’ than physically. Can’t quite believe but hey ho. They don’t shock me anymore. Lack of thyroid knowledge and general empathy! That’s gps!
My query is, I have lowered my t4 to 50mcg as my Endo suggested 3 weeks ago, so it is now 50mcg T4 and 10mcg T3. I was on 62.5 mcg T4. Do I add the other half of T4 back in to see if it helps the lethargy I feel? Bearing in mind these results are around 3 weeks old now before dose alterations.
I wish I could up the T3 more instead of adding more T4 as that’s the thing that makes me feel more alive, I’ve posted these before but my most recent bloods:
T4 14pmol/l range 9-21 pmol/L
total T3 1.3nmol/l range unsure
TSH 0.98mU/l range 0.2-4.5 mU/L
Folate 12.6 range unsure but doctor wrote normal
B12 501 ranges 180-2000ng/l
Ferritin 47 ranges 15-200 ug/l
Iron 7 ranges 10-28umol
Vitamin D - 90 medichecks said it was over average so good
My iron on 22 March was 14.6 ranges 10-28umol/L
No FT3 but I plan on ordering in 4 weeks to see where I’m at. Should I go back up the half T4 pill to 62.5mcg or leave it as is just now to see how I am?
Any advice would be much appreciated 😊
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mistygrey
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I think I need to up my T4 again slightly as 50mcg seems far too low! Hopefully you get on good with that dose, I know it’s a small dose of T3 but I do feel the difference and more alive,
Now I believe everybody who tells me it saved their lives! 😊
It really depends how well you convert. And, we have no way of knowing that. But if you can't convert the T4 very well, not much point in increasing it.
Might a thyroid genetic test be a good idea. It would help mistygrey find out if she has a conversion problem caused by a faulty Dio2 gene. Granted there might be other reasons like suboptimal nutrient levels but maybe an idea since she has already started to add T3. I found it very useful despite the fact that I had already been advised here that my conversion was poor on T4 only. Medics are more likely - though not always - to take cognisance of that lab result.
I have no opinion on the DIO2 gene test. But, I don't believe the majority of doctors are likely to take notice of it because they will have no idea what it is. Most of them don't even know what T3 is.
Oh dear, I just thought it might confirm a conversion problem and as a consequence the need for added T3 which currently seems only to be supposed because no FT3 test was carried out before T3 was added.
As you know I have always valued your opinion and thought I would ask for your thoughts on my suggestion.... I had based that on your comment, "Yes, but we can only judge your conversion if you are on T4 only. Once you add in the T3, there's no way of knowing." ...and on my experience.
I'm sorry if I got it wrong....
However, the doctors may or may not be interested but surely it gives the patient a better understanding of their thyroid function....and a starting point to learn more about self medicating. It is impossible to make an informed choice without first being well informed.....and this forum mistygrey is a tremendous source of information, opinion and advice.
I don't know enough about genetics to have an opinion. But, from what I've read, the test does not give you proof positive that you have a conversion problem, just the possibility of poor conversion.
But the DIO2 gene has nothing to do with the functioning of the thyroid gland, as far as I know. You don't have to know about your genetics to self-treat. You can see if you after converting badly by comparing the FT4 with the FT3. And that is enough to tell you if you need T3. That said, given that the thyroid produces T3 as well as T4, a little T3 would never go amiss. And the body will adjust the conversion of T4 accordingly. And even if you convert perfectly - as I did - T4 only is not always the correct treatment. I needed to be on T3 only. But, I have never felt the need of a DIO2 gene test.
I understand all that, but mistygrey doesn't appear to know if she is converting adequately, and having added T3 is now no longer able to rely on a T4/T3 comparison ....for the reason you explained.
You told mistygrey who has added T3 "...but we can only judge your conversion if you are on T4 only. Once you add in the T3, there's no way of knowing."
And then you reply to me, "You can see if you are converting badly by comparing the FT4 with the FT3. And that is enough to tell you if you need T3. That said, given that the thyroid produces T3 as well as T4, a little T3 would never go amiss. And the body will adjust the conversion of T4 accordingly."
I understand that but it doesn't address the original issue - the identification of poor conversion after the addition of T3.
My question is, how then is mistygrey (or anyone else in her position) supposed to find out if their T4 to T3 conversion is poor? Have I missed something?Maybe I have been mistaken but I understood that identifying poor conversion is (in many cases) key to improving treatment.
I was only trying to be helpful when I raised the idea of a genetic test. It would identify whether or not a polymorphism existed in the Dio2 gene which in turn indicates poor T4 to T3 conversion. If this is the case then combined T4/T3 is said to overcome this. Dio2 is responsible for local conversion of T4 to T3....these are the words of a geneticist, not mine.
I guess mistygrey may have lost interest in this thread but genetic testing is with us now....and I thought, maybe mistakenly, that it was pertinent here. By promoting the tests TUK must see some value in them.....I simply wondered what your opinion was.
I'm just naturally curious....and we know what that did to the proverbial cat!!
Dippy, if you keep taking things out of context, you're bound to get confused. And, to be honest, does it really matter if she converts well or not? That is not the point of this thread. The question was : should I add in more T4. I suppose I should just have said no, increase the T3, then no-one would have got confused.
I understand perfectly that you were only trying to help. Did I say you weren't helping? But, for some reason, you asked me my opinion on DIO2 testing. I replied : I have no opinion. That is all there is to say. I have no opinion. I don't know how else I can explain that. I just have no opinion either way. Why go on about it? Does it actually matter what I think about DIO2 testing? I think not. There are plenty of other people that have opinions on it, why not ask one of them?
Genetic testing is with us. Fine. I really don't care. I won't be with us for much longer, so it's not really that important for me. And I just don't care. I am not going to go spouting off on a subject I know nothing about. End of.
You're welcome. But, someone is bound to come along and say that they also need their T4 'in an optimal range' (whatever that means) even though they're taking T3. And, it's perfectly possible that, eventually, you might need to add in a little more T4 to feel your best. On the other hand, you could feel the need to reduce it. It's all trial an error, so better if we take things one step at a time. First, sort your T3 out, and then worry about the FT4 after. Hope that's not confusing. lol
No no that makes perfect sense 😁 I will give this a few weeks retest and come back with results that might better help you see where things are at to advise then 😊
I'm very sorry that I've upset you ....you mentioned conversion, that is why I mentioned the test...info for mistygrey etc... and no, it never crossed my mind that you considered I wasn't helping.
I'm not upset. I just don't understand why you keep going on about it. And I had no idea what you wanted me to say. And I don't know why you didn't address your remarks, your info, directly to the OP - why involve me?
I'm not expecting a response, as you indicated, but just to be clear, what I am "going on about" is this - how to identify poor conversion after the addition of T3. The post was about T3....
I wrote, "My question is, how then is mistygrey (or anyone else in her position) supposed to find out if their T4 to T3 conversion is poor"... after the addition of T3 A genetic test seemed one option hence my reference to same.
However, your later response to mistygrey provided an answer, "If you were a poor converter, the only thing you would be able to do is add T3. So, forget about conversion, it is now irrelevant."
You raised the topic of conversion which is why I responded to you rather than the OP.
I feel I have to answer this, Dippy, because you're absolutely barking up the wrong tree and taking things out of context again, in the above response to me, and to Kell-E below.
Firstly, you didn't ask me if the DIO2 test was a good way to find out how you convert. You just asked me what I though about the test. I answered that question: I don't know enough about it to have an opinion. Even if you'd asked the right question, I would still have had to say that I don't know, I don't know if it is a good way to find out about conversion because I've read that the results are not definitive, just indicatif - i.e. it may affect your conversion and it may not. But, I don't know if that is the truth or if it is someone else's biased opinion.
As for taking things out of context, again. In your response to Kell-E you say :
Then...I read here that conversion is irrelevant, but it is also pointed out that the person would then need to be a poor converter .... fine.....but that fact still hadn't been confirmed....so back to my question.
No, you didn't read here that conversion is irrelevant. Of course it's not irrelevant, how could that possibly be true? What I said was that it was now irrelevant to the OP because she was now taking T3 anyway. Please, you've got to stop doing that! Taking the odd word here and there out of a sentence and making it into something it isn't. You have to read to the end of the sentence because all the words are important and make up the sense of the idea, you can't just stop in the middle.
Normally, before starting T3, people would get their FT4 and FT3 tested to see how well they were converting. Not to see how much T3 they should be taking, don't think that. Because, even if they do convert well, they can still take T3, they just need to know if they should reduce their dose of levo. And, then, they follow the rules for starting hormones - all hormones : start low and increase slowly.
As I mentioned before, this thread is not actually about T3, despite the title. The question was, should I increase my levo. Maybe if I'd answered differently, I might have avoided all this, but what I actually said was : depends how well you convert. It could have been that the OP has some labs from her time on levo only that showed how well she converted. Turns out she didn't. Hence my comment that, as she'd already started on T3, her conversion rate was now irrelevant, anyway, and to carry on with the T3. She could think about the T4 later. That is all this is about. We weren't looking for ways of determining conversion after starting T3, which wouldn't be a first priority, anyway.
I do hope I've now cleared up any doubts you may have had about conversion and adding T3. But I still don't know enough about the DIO2 test to give an opinion. If you have any other questions, please don't hesitate to ask them. But please do not take things I've said out of context.
Just noticed your response, thank you for your concern. Had a really bad spell but slowly improving...shocking what hypo does to the (old) brain and body!
My brain must have been more foggy than I thought because I now realise I need not have asked that question at all. I guess cutting out T3 - in the OP's case, she initially pointed out a small amount of 5mcg had been added - and clearing it from the system before having another test would then achieve FT4 and FT3 lab results that could be used to calculate the possibility of poor conversion.
I suppose we all lose the plot at times...
I enjoyed your reminder on how to analyse a sentence...good job my professional life is long behind me!
As L.P. Hartley wrote, "The past is a foreign country....."
There are so many reasons that conversion can be poor. Stress, exposure to toxins, chronic illness, inflammation, dieting, etc. In a situation where your doctor is refusing T3, a positive result on the genetic test may be helpful to your argument. Otherwise I'm not sure it is of great value. You could have a result that suggests the genetic problem and have poor conversion that is really attributable to something else. Or you could have multiple reasons for poor conversion.
Thank you @Kell-E .. ok, there are several reasons for poor conversion...and there appears to be only one way to confirm that this is a problem... i.e. a blood test which compares T4 and T3 levels when only T4 is added. Understood.
My question which I thought was straightforward .....sorry, becoming tedious now and appearing like a dog with a bone!!...how can someone confirm (or not) poor conversion if they have already started to add T3, which would skew results and therefore make it impossible to draw that conclusion?
It's not the causes of poor conversion that concerns me...and I really appreciate your reply..but the method/significance of confirming poor conversion. Why does this matter? ..without that info how does one begin to titrate T4/T3?. Add T3 to T4....cut T4 and add T3... use T3 only...or cut T4?
Then...I read here that conversion is irrelevant, but it is also pointed out that the person would then need to be a poor converter .... fine.....but that fact still hadn't been confirmed....so back to my question.
I can only conclude that it becomes an endless case of trial and error....it can be difficult enough doing this when poor conversion is established.
That is why I suggested a genetic test may be useful, but that was taken as the issue rather than that of verifying poor conversion....which I thought I had clarified...but clearly not!
Thus, I found myself in the position of trying to explain this, and, with a focus on genetic testing now muddying the waters I ended up in this uncomfortable position.
I appear to have caused upset where none was intended.....and I now regret that I got involved in the first place. I felt I was entitled to justify my comments...maybe that was my mistake!
So if I get a FT3 test it will help show how I am converting? As mentioned below I have been on T3 now but somebody else mentioned it’s more accurate to show how you are converting whilst on T4 alone and if that’s the case I am not going to get a good result as I am on combination T3/T4 😊
No. Testing your FT3 now will not show how well you were converting because you have added in the T3. But, does it really matter given that you are taking T3 anyway. If you were a poor converter, the only thing you would be able to do is add T3. So, forget about conversion, it is now irrelevant.
However, as you are taking T3, you do need your T3 tested so that you don't over-dose. So, you've got to do it anyway.
That is difficult to say for sure. Your TSH has room to drop, so your body's own production may lessen when you add more T3. Lower TSH will also result in less conversion of T4 to T3. There are so many factors in play that it's pretty much an experiment. If you leave your T4 at 50 and adding more T3 makes you feel worse or no better, then maybe consider dropping T4 to 25.
Not really I most likely don’t convert well as Hashis so it wouldn’t be a surprise if I found out I was badly converting as I think most Hashi people are anyway
My GP believes that pretty much no one converts particularly well because of exposure to fluoride, bromine, metals...not to mention chronic stress and inflammation. Obviously some of us have more of a problem than others.
I was on 150mcgs of T4 when my endo agreed to me adding 20 mcgs of T3. He told me to reduce the T4 to 100mcgs. I started to feel so much better. I had already sent away a test for DIO2 and before my next endo visit it came back showing that I was heterozygous (1 copy) for DIO2, which means I may not be able to effectively convert T4 to T3. I showed this to my endo. He said I could increase the T3 to 30mcgs per day. I asked him should I reduce T4 and he said no, it was OK to leave it where it was. He hadn't tested FT3 even though he had put me on T3. He only tested it that afternoon when I taken my T3 and hadn't fasted so I got a false high reading. (he's the head of the department too). It looked as though I was mildly over-medicated on T3 with a reading of 7.8 (range of 3.6 to 6.4). I had a fasting test on Friday at my GPs (still on same dose) I was waiting for the letter from endo to GP to confirm my previous test result. Anyway Friday's result is FT3 5.6 (range of 3.1 to 6.8), so scope for an increase. I have today started increased T3 of 30mcgs, but I have not reduced the T4. I just thought that my experience may help you. As others have said, I would not increase the T4 but would slightly increase the T3 if you feel you need it. But just remember, more is not always better (it can cause more problems) and you need to leave a reasonable time between increases to really understand how the increase has affected you. I just thought that my experience may help you. It's a very long and slow process I'm afraid. By the way I have Hashimoto's disease.
I think Mistygrey that you need to be careful with that vitamin D, it's toxic and being one of the non-soluble vitamins it builds up. Also it's now called a pro-hormone and the body can be very sensitive to it and react badly to too much.
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